Rapid Clinical Updates: Antibiotic Stewardship in Pneumonia-Slides

Slides

Pdf Summary

This educational session on antibiotic stewardship in pneumonia features experts Drs. Moira McNulty, Paul Caseley, and moderator Joseph Sweigart, providing rapid clinical updates with emphasis on community-acquired pneumonia (CAP).<br /><br />Key points include updated definitions: CAP occurs outside healthcare settings; hospital-acquired pneumonia (HAP) arises 48+ hours after admission; ventilator-associated pneumonia (VAP) affects ventilated patients 48+ hours. The HCAP category was eliminated to reduce unnecessary broad-spectrum antibiotic use.<br /><br />CAP accounts for substantial morbidity and mortality; up to 10% require hospitalization. Diagnosis of CAP is often overused, with 10-30% lacking confirmatory clinical and radiographic evidence. Differentiation between uncomplicated vs. complicated and severe vs. non-severe CAP guides testing and treatment. Complicated CAP involves local/systemic issues like empyema or septic shock. Immunocompromised patients require special consideration and often longer therapy.<br /><br />Initial antibiotic therapy for non-severe CAP typically includes a beta-lactam plus macrolide or fluoroquinolone monotherapy, without need for routine blood cultures or urinary antigen tests unless severe. Ancillary testing is reserved for severe cases or treatment failure. Empiric anti-MRSA or antipseudomonal coverage is indicated only with specific risk factors (prior isolates, recent IV antibiotics, local epidemiology). A negative MRSA nasal swab allows safe discontinuation of anti-MRSA agents.<br /><br />Updated evidence supports shorter antibiotic durations: 3 days for stable outpatients, 3-5 days inpatient depending on clinical stability (absence of fever, stable vitals). Longer courses (7+ days) remain for severe CAP or confirmed Staphylococcus aureus/pseudomonas infections. Corticosteroids are not recommended for non-severe CAP but may benefit severe CAP except in influenza infection.<br /><br />Prevention strategies include vaccination (pneumococcal, influenza, RSV, COVID-19), smoking cessation, and oral hygiene. For HAP/VAP, combination gram-negative coverage and routine anaerobic coverage are discouraged; 7-day antibiotic courses are typical, with shorter courses possible in select VAP.<br /><br />Stewardship benefits reported include improved outcomes, reduced length of stay, decreased Clostridioides difficile infection, reduced antibiotic resistance, less kidney injury, and lower costs.<br /><br />In summary, evidence-based stewardship in pneumonia emphasizes accurate diagnosis, targeted empiric therapy with appropriate narrow-spectrum antibiotics, minimal ancillary testing unless indicated, and shorter treatment durations guided by clinical stability to optimize patient outcomes and minimize adverse effects.

Keywords

antibiotic stewardship

community-acquired pneumonia

hospital-acquired pneumonia

ventilator-associated pneumonia

beta-lactam therapy

macrolide antibiotics

fluoroquinolone monotherapy

MRSA nasal swab

short-course antibiotic therapy

pneumococcal vaccination